ABCD before E-verything else-Intensive care nurses' knowledge and experience of pressure injury and moisture-associated skin damage.

Patients in intensive care units are at high risk of developing pressure injuries and moisture-associated skin damages. Prevention and care rely much on intensive care nurses' competency and attitudes. This study explored intensive care nurses' experience, knowledge and bedside practice in prevention and care of pressure injuries and moisture-associated skin damages with a descriptive qualitative design. Six focus groups (n = 25) were carried out in three University hospitals, two in Norway and one inIceland. Interviews were guided by a questioning route, recorded and transcribed verbatim before an inductive content analysis. Three interconnected main categories related to nurses' experience, knowledge and bedside care were identified: (a) nursing; (b) context; and (c) patients. Intensive care nurses recognise patients' risk of developing pressure injuries, as well as their continuous need of personal hygiene because of leakage of body fluids. Nurses were therefore attentive to skin inspection and preventive care but felt insecure and in need of expert help in pressure injury wound care. It varied whether nurses had access to suitable beds and mattresses and experts in wound care. ABCD had to be before E-verything else, but the skin had higher priority in long-stay compared with short-stay patients.

Interface Pressures of New and Worn Standard and Viscoelastic Hospital Mattresses: A Comparative Study.

Hospital mattresses have been found to be used for up to 10 years in Norway. Few studies have investigated how wear and tear affects foam qualities. PURPOSE: This descriptive comparative study investigated interface pressures in a sample of 5 new and worn standard and viscoelastic hospital mattresses and compared their comfort and mobility ratings. METHODS: Using convenience sampling methods, 20 healthy individuals (75% female, average age 41.3 years [SD ± 12.25]) volunteered to lay supine for 10 minutes on 5 different mattresses. Mattresses had been in use for up to 7 years (since 2011). Using a bed-size pressure mapping system, interface pressures (mm Hg) were obtained after 10 minutes. Comfort and ease of turning oneself (very poor to very good) were evaluated after the pressure mapping was completed. RESULTS: Differences were found between viscoelastic mattresses and standard mattresses, with mean interface pressures ranging from 30.28 to 38.37 mm Hg (P = .011), and for the mean number of cells 60 mm Hg or above (P = .025) and 80 mm Hg or above (P = .046) between the different mattresses after 10 minutes. One standard mattress from 2014 had the highest mean interface pressure (38.37 ± 7.43 mm Hg). Viscoelastic foam mattresses had the highest comfort, and standard mattresses had the highest ease of mobility scores; however, the differences were not significant. The mean interface pressures differed between participants weighing > 100 kg and those weighing < 100 kg on the standard mattress from 2011 (46.50 ± 4.83 vs. 33.86 ± 5.83; P = .012). Similarly, the values were 41.25 ± 7.70 versus 29.78 ± 5.99 on the new viscoelastic mattress (P = .040) and 42.87 ± 4.09 versus 28.05 ± 6.16 (P = .012) on the old viscoelastic mattress. CONCLUSION: Older standard mattresses were found to be less comfortable and had higher interface pressures compared to the new standard and viscoelastic foam mattresses.

Effect of e-learning program on risk assessment and pressure ulcer classification - A randomized study.

BACKGROUND: Pressure ulcers (PUs) are a problem in health care. Staff competency is paramount to PU prevention. Education is essential to increase skills in pressure ulcer classification and risk assessment. Currently, no pressure ulcer learning programs are available in Norwegian. OBJECTIVES: Develop and test an e-learning program for assessment of pressure ulcer risk and pressure ulcer classification. DESIGN, PARTICIPANTS AND SETTING: Forty-four nurses working in acute care hospital wards or nursing homes participated and were assigned randomly into two groups: an e-learning program group (intervention) and a traditional classroom lecture group (control). Data was collected immediately before and after training, and again after three months. The study was conducted at one nursing home and two hospitals between May and December 2012. ANALYSIS: Accuracy of risk assessment (five patient cases) and pressure ulcer classification (40 photos [normal skin, pressure ulcer categories I-IV] split in two sets) were measured by comparing nurse evaluations in each of the two groups to a pre-established standard based on ratings by experts in pressure ulcer classification and risk assessment. Inter-rater reliability was measured by exact percent agreement and multi-rater Fleiss kappa. A Mann-Whitney U test was used for continuous sum score variables. RESULTS: An e-learning program did not improve Braden subscale scoring. For pressure ulcer classification, however, the intervention group scored significantly higher than the control group on several of the categories in post-test immediately after training. However, after three months there were no significant differences in classification skills between the groups. CONCLUSION: An e-learning program appears to have a greater effect on the accuracy of pressure ulcer classification than classroom teaching in the short term. For proficiency in Braden scoring, no significant effect of educational methods on learning results was detected.

Patient and organisational variables associated with pressure ulcer prevalence in hospital settings: a multilevel analysis.

OBJECTIVES: To investigate the association of ward-level differences in the odds of hospital-acquired pressure ulcers (HAPUs) with selected ward organisational variables and patient risk factors. DESIGN: Multilevel approach to data from 2 cross-sectional studies. SETTINGS: 4 hospitals in Norway were studied. PARTICIPANTS: 1056 patients at 84 somatic wards. PRIMARY OUTCOME MEASURE: HAPU. RESULTS: Significant variance in the odds of HAPUs was found across wards. A regression model using only organisational variables left a significant variance in the odds of HAPUs across wards but patient variables eliminated the across-ward variance. In the model including organisational and patient variables, significant ward-level HAPU variables were ward type (rehabilitation vs surgery/internal medicine: OR 0.17 (95% CI 0.04 to 0.66)), use of preventive measures (yes vs no: OR 2.02 (95% CI 1.12 to 3.64)) and ward patient safety culture (OR 0.97 (95% CI 0.96 to 0.99)). Significant patient-level predictors were age >70 vs <70 (OR 2.70 (95% CI 1.54 to 4.74)), Braden scale total score (OR 0.73 (95% CI 0.67 to 0.80)) and overweight (body mass index 25-29.99 kg/m(2)) (OR 0.32 (95% CI 0.17 to 0.62)). CONCLUSIONS: The fact that the odds of HAPU varied across wards, and that across-ward variance was reduced when the selected ward-level variables entered the explanatory model, indicates that the HAPU problem may be reduced by ward-level organisation of care improvements, that is, by improving the patient safety culture and implementation of preventive measures. Some wards may prevent pressure ulcers better than other wards. The fact that ward-level variation was eliminated when patient-level HAPU variables were included in the model indicates that even wards with the best HAPU prevention will be challenged by an influx of high-risk patients.

The prevalence, prevention and multilevel variance of pressure ulcers in Norwegian hospitals: a cross-sectional study.

BACKGROUND: Pressure ulcers are preventable adverse events. Organizational differences may influence the quality of prevention across wards and hospitals. OBJECTIVE: To investigate the prevalence of pressure ulcers, patient-related risk factors, the use of preventive measures and how much of the pressure ulcer variance is at patient, ward and hospital level. DESIGN: A cross-sectional study. SETTING: Six of the 11 invited hospitals in South-Eastern Norway agreed to participate. PARTICIPANTS: Inpatients ≥18 years at 88 somatic hospital wards (N=1209). Patients in paediatric and maternity wards and day surgery patients were excluded. METHODS: The methodology for pressure ulcer prevalence studies developed by the European Pressure Ulcer Advisory Panel was used, including demographic data, the Braden scale, skin assessment, the location and severity of pressure ulcers and preventive measures. Multilevel analysis was used to investigate variance across hierarchical levels. RESULTS: The prevalence was 18.2% for pressure ulcer category I-IV, 7.2% when category I was excluded. Among patients at risk of pressure ulcers, 44.3% had pressure redistributing support surfaces in bed and only 22.3% received planned repositioning in bed. Multilevel analysis showed that although the dominant part of the variance in the occurrence of pressure ulcers was at patient level there was also a significant amount of variance at ward level. There was, however, no significant variance at hospital level. CONCLUSIONS: Pressure ulcer prevalence in this Norwegian sample is similar to comparable European studies. At-risk patients were less likely to receive preventive measures than patients in earlier studies. There was significant variance in the occurrence of pressure ulcers at ward level but not at hospital level, indicating that although interventions for improvement are basically patient related, improvement of procedures and organization at ward level may also be important.